Othr-03 Infectious Complications of Endoscopic Endonasal Approach: Case Report and Review

BACKGROUND The innovative concept of rapid access to the sellar region was first demonstrated by Davide Giordano, an Italian anatomist, in 1897. In the 1990s, the introduction of rigid endoscopes gave rise to the trans-sphenoidal endonasal approach. This approach is always fraught with complications, the most frequent of which is CSF leakage. Infections on dural refection material in endonasal endoscopic surgery are rarely reported in the literature. We report a case of infection of the closure fat of a CSF breach after pituitary endonasal endoscopic surgery. CASE REPORT A 50-year-old patient was treated for a pituitary adenoma. He presented with left temporal hemianopia, decreased visual acuity, and acute headache. MRI revealed a heterogeneous sellar lesion compressing the chiasma. Endonasal endoscopic resection was performed, followed by plasty using a bone pack and sealing the sellar turcica with the middle turbinate. The postoperative period was complicated by rhinorrhea, which required repeat surgery and plasty using fat and fascial grafts and an external lumbar bypass. A few weeks after the operation, the patient reported frontal discomfort. Cerebral MRI revealed filling of the right sphenoidal sinus with the appearance of retention. Intraoperatively, a purulent discharge from the sphenoidal meatus and a greenish pateous formation were found and removed. Anatomopathological examination revealed a lesion compatible with aspergillosis, with no signs of malignancy. Mycological examination revealed section flavi aspergillus. CONCLUSION The endoscopic endonasal approach is an essential component of modern minimally invasive surgery. Despite the advantages of this approach, complications are possible. Infection of the dural defect reconstruction material is rare and its risk of occurrence is correlated with the patient’s state of health and co-morbidity.